For purposes of this subchapter—

(1) the term “Alaska Native” has the meaning given the term “Native” in section 1602 of title 43;

(2) the term “infant or toddler with a disability” has the meaning given the term in section 1432 of title 20;

(3) the term “Native Hawaiian” has the meaning given the term in section 7517 of title 20;

the term “sexual abuse” includes—

(A) the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or

(B) the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children; and

the term “withholding of medically indicated treatment” means the failure to respond to the infant’s life-threatening conditions by providing treatment (including appropriate nutrition, hydration, and medication) which, in the treating physician’s or physicians’ reasonable medical judgment, will be most likely to be effective in ameliorating or correcting all such conditions, except that the term does not include the failure to provide treatment (other than appropriate nutrition, hydration, or medication) to an infant when, in the treating physician’s or physicians’ reasonable medical judgment—

(A) the infant is chronically and irreversibly comatose;

(B) the provision of such treatment would— (i) merely prolong dying; (ii) not be effective in ameliorating or correcting all of the infant’s life-threatening conditions; or (iii) otherwise be futile in terms of the survival of the infant; or

(C) the provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane.

For purposes of section 3(2) [1] and subsection (a)(4), a child shall be considered a victim of “child abuse and neglect” and of “sexual abuse” if the child is identified, by a State or local agency employee of the State or locality involved, as being a victim of sex trafficking (as defined in paragraph (10)  of section 7102 of title 22) or a victim of severe forms of trafficking in persons described in paragraph (9)(A)  of that section.

(1) In general For purposes of section 3(2) [1] and subsection (a)(4), a child shall be considered a victim of “child abuse and neglect” and of “sexual abuse” if the child is identified, by a State or local agency employee of the State or locality involved, as being a victim of sex trafficking (as defined in paragraph (10)  of section 7102 of title 22) or a victim of severe forms of trafficking in persons described in paragraph (9)(A)  of that section.

(2) State option Notwithstanding the definition of “child” in section 3(1),1 a State may elect to define that term for purposes of the application of paragraph (1) to section 3(2) 1 and subsection (a)(4) as a person who has not attained the age of 24.

(Pub. L. 93–247, title I, § 111, formerly § 14, as added Pub. L. 100–294, title I, § 101, Apr. 25, 1988, 102 Stat. 116; renumbered title I, § 113, and amended Pub. L. 101–126, § 3(a)(1), (2), (b)(7), Oct. 25, 1989, 103 Stat. 764, 765; renumbered § 111 and amended Pub. L. 104–235, title I, §§ 110, 113(a)(1)(B), Oct. 3, 1996, 110 Stat. 3078, 3079; Pub. L. 111–320, title I, §§ 119, 142(b), Dec. 20, 2010, 124 Stat. 3477, 3483; Pub. L. 114–22, title VIII, § 802(c)(1), (3), May 29, 2015, 129 Stat. 264; Pub. L. 114–95, title IX, § 9215(o), Dec. 10, 2015, 129 Stat. 2170.)